Since the show went out, I’ve had several requests from people to publish the email and my reply. So here it is in full, save for the redaction of Emily’s full name and email address.

From: EmilyTo: contact@1023.org.ukSubject: Hi..

I would like to know, have you tried Homeopathy? Properly, I mean. Have you been to a Homeopath for a certain length of time and taken the remedies as prescribed?

I’m just curious. Because if you did you may think differently about the whole subject.. And it would seem odd to argue against something so strongly if you’ve never actually tried it.(Especially as it isn’t actually harmful -It’s not like I’m saying “You don’t know about heroin – you haven’t tried it.”

I have been seeing a Homeopath for about 3 years now. She got me off my anti-depressants steadily and very, very carefully – and I am now leading a normal life again. Most problems I’ve had – which are now few and far between – have all been sorted out by taking Homeopathic remedies. I’m a 26-year-old woman, who was occasionally given Arnica as a child, but had never really tried Homeopathy until a few years ago. I got very low and depressed after University and was put onto strong medication. It sent me up and down and all over the place. Of course, it worked for a bit. But all it really did was suppress what was still there. It wasn’t getting to the root of the problem – the emotional problem. Anyway, my sister was training to be a Homeopath and through her I met Caroline, another student of the same Homeopathy college. She’s been treating me ever since – and because she met me through the college she still only charges me £15 every time I see her – which is about every two months. (Hardly money-grabbing!) I never really believed it would work – and sometimes it doesn’t completely. Sometimes it can makes something a little worse or aggravate it. Because my homeopath doesn’t always get it right. The body is a incredibly complex! But she gets it right nearly every time – and more than most doctors I’ve seen.

Anyway, what I’m trying to say is, how can it be a placebo? I’ve seen it work on my uncle who was against homeopathy probably more than you guys! But he tried it – because he was in agony with his elbow. And low and behold.. Yep you guessed. As I sometimes say, he also says “I don’t know, and don’t care, how it works – but it works!” It works on children and babies. It’s worked on animals.

I’ve always been in and out of doctors for various problems. Now I never need to go. And, no, I’m not putting myself at risk. Homeopathy isn’t harmful. I Choose to see a Homeopath.

To be honest I don’t think I’m ever going to need to take a packet of antibiotics ever again. And that makes me actually pretty happy. I feel cleansed and healthier than I have ever been! I Choose not to go to the doctor anymore. I can make these decisions. It’s not forced upon anyone to take alternative forms of medicine. Yes, it is more expensive because it is not widely available on the NHS. And I’m kind of glad it isn’t. Because if it’s not prescribed properly – well, what’s the point? The price Homeopaths charge I find is pretty reasonable for the amount of effort that goes into a session. My sister doesn’t make a lot of money from being a Homeopath. But it gives her a lot of satisfaction knowing that she has really helped someone. To be honest, I’ve not met one person who has tried it that it hasn’t worked for.

It kind of stresses me out sometimes when there are so many people out there with so much hatred towards it. SO much anger and so against something that they probably have never tried. Something that has helped a LOT of people – 15% of the UK population swear by it apparently.

Anyway, I know this is a bit of a ranting email. And I’m not even sure if you will read to the end. But I’m not going to insult your intelligence – I’m going to assume that you have read it and taken it in.
There’s not much else I can say – but I guess sometimes you’ve just got to stick up for what you believe in! Remember people used to say that the earth is flat and laughed at those that told them otherwise?

Keep safe and try not to bash something that you may or may not know much about. I don’t know what you know or think you know – but just try to keep an open mind. You may be happier for it 🙂

Thanks,

Emily

P.s. The reason your “overdose” didn’t work, is because homeopathic remedies aren’t made up of chemicals. They aren’t drugs.

That’s it really. Now you can sleep at night 😉

From: Mike HallTo: EmilySubject: Re: Hi..

Hi Emily,

Thanks for your email — and particular thanks for your measured, reasonable and thoughtful tone. It is very much appreciated.

I’m really happy that homeopathy helped you quit your anti-depressants and that your health has improved. The concern I have with your story (and your suggestion that we should try homeopathy before criticising it) is that I do not believe our own personal experiences are very reliable when it comes to figuring out which medicines work and which don’t.

Consider the situation where I have a nasty skin condition. I visit a homeopath, who specifies a remedy for me. And I take the remedy as described and the skin condition clears up. How do I know that the homeopathy is what cleared up my skin? Unfortunately, I don’t. I know that I took the homeopathy, and I know that I got better afterward. But I don’t know that the homeopathy caused my recovery, because I don’t know what would have happened if I hadn’t taken it. Maybe my skin would have cleared up anyway. Maybe it would have cleared up even faster, but the homeopathy actually stopped it from clearing up as fast as it might. Maybe my skin wouldn’t have cleared up at all. All of these are possible — and I don’t know which is really the case. All I can do is make guesses about what would have happened, and if my guess is wrong then I end up misleading myself about what effect the homeopathy had.

For this reason, scientists do not rely upon personal experience to judge the effect of an intervention like this. Instead, they perform controlled trials. You take a load of people, you split them into two groups. Half of them are given homeopathy, half of them are given placebos, and you measure the differences between the two groups in the way they recover. People in both groups will get better — for a variety of reasons.

There is an effect known as “Regression to the Mean”, where chronic conditions tend to wax and wane over time, flaring up and dying back… “good days” and “bad days”. The pattern we observe is that, after one or two bad days the condition will settles down, and after a good day or two the condition might flare up. But it always returns to the mean, to the average state. So, say it was a painful joint — and on average you said it was a 3/10 on the pain scale. Some days it might be 5/10 or 6/10, some days it might just be 1/10. But over time, it will always return to around 3/10. As I said, this is called Regression to the Mean.

Now let’s say you were having a bad day, and you went to see a homeopath. In fact, you’re more likely to go and see a homeopath on a bad day, because your condition is worse than usual and people will tend to seek medical help when their symptoms are at their peak. So you go to see a homeopath on a 6/10 day and they give you a remedy. You take it, and you settle down to a 3/10 or maybe even 1/10. Does that mean the homeopathy worked? No — because Regression to the Mean says that you were going to do that anyway, with or without an intervention. It’s just the nature of your condition.

There are other effects, like the natural history of the disease. You start vomiting very badly and you can’t hold anything down — barely even water. You go to see your homeopath and get a remedy. You take it, and in a day or so you’ve stopped vomiting and you feel better. Does this mean that the homeopathy made you better? No, because you were vomiting because of the norovirus. Norovirus is a self-limiting condition that clears up after a day or two anyway. Yes, you took the homeopathy. Yes, you got better afterward. But you didn’t get better because of the homeopathy, you got better because your immune system fought off the disease — which it would have done anyway.

There are many dozens of these types of effects which have to be accounted for when you try to figure out if any medical intervention is effective. Going back to our big group of patients… half of them get homeopathy, half of them don’t. People in both groups will recover, because of effects like regression to the mean and the natural history of the disease. But the important question is — do more people get better in the homeopathy group compared to the placebo groups?

Some tests say “yes they do” and other tests say “no they don’t”. But the tests that say “yes”, tend to be with smaller groups of people and are therefore more likely to see “false positive” results, where one group does better than the other just by chance. The tests that say “no” tend to be of larger groups of people, where false positives and negatives are less likely to happen. When you have a body of conflicting evidence like this, scientists perform what is called a systematic review. This is where they look at all the tests that have been published, discard the ones which have the poorest statistical power (via a set of rules defined before the review was started) and then analyse the tests we have remaining.

When systematic reviews like this are done for homeopathy, it shows that, in-fact, there is no effect from homeopathy. Yes, patients who take homeopathy are getting better — which is great! But they aren’t getting better because of homeopathy, they are getting better because of a raft of other, unrelated, effects. We know this because patients who aren’t taking homeopathy are just as likely to get better as ones who are, in our comprehensive review of the data.

Just a final couple of things to address specific points that you made:

First, you said that sometimes you go to your homeopath and you get worse. And you also say that this is because your homeopath doesn’t always get it right. Some homeopaths refer to this as a “healing crisis” and argue that you will “get worse before you get better”. Other homeopaths do not make this claim, and I don’t know about yours. But — consider the effects of regression to the mean. If you’re having a bad couple of days, and you go to see the homeopath on the first day. You get a remedy, you take the remedy. The next day, you’re even worse! This isn’t because of the homeopathy, it’s because you’re having a bad couple of days. After the bad couple of days, things settle down again, you “regress to the mean” and you get better. A homeopath might say that is your body having a “healing crisis” and then recovering. You said it was because sometimes your homeopath gets it wrong. But there is this known effect that we can observe and measure — regression to the mean — which also accounts exactly for what happened. How can you rule out regression to the mean as an explanation? In individual cases, we unfortunately can’t, which is why we need to look at controlled trials and systematic reviews, not individual cases.

Maybe this isn’t a chronic condition, maybe this is acute. As I said earlier, people tend to seek medical attention when their symptoms are at their worst — but say you went the day before they were at their worst? You go to the homeopath, you get your remedy, you take it and the next day you are even worse. Then the day after you start getting better and them you recover. Again, there is this known effect which explains what you describe, but doesn’t have anything to do with homeopathy. Again, how can we rule out this effect? In individual cases we can’t, because we don’t know what would have happened without the homeopathy.

Again, this is why we need to base our decisions on trials and reviews.

Second, you say (paraphrasing, forgive me) “How can it be a placebo? It worked on my uncle who didn’t believe, it works on babies and it works on animals”. The placebo effect is (or rather, ‘placebo effects are’ – as there are several!) very widely misunderstood, even amongst doctors and scientists. But consider the two effects I have described, regression to the mean and the natural history of the disease. They would mean babies receiving placebos can still get better. They would mean animals receiving placebos can still get better. They would mean that someone taking a placebo and thinking it won’t work can still get better.

On top of that, you also have psychological effects, which we sometimes refer to as “placebo by proxy”. If a horse has an injured ankle, it can’t tell you how much pain it is in. It can’t tell you how difficult it is to put weight on their hoof. Instead, we have to rely on the judgement of the owner or the vet to figure out how much pain the horse is in. Let’s assume for a moment that the horse’s ankle does not get better at all. The owner can see his horse is limping and in pain, and calls the homeopathic vet. The horse is given a homeopathic remedy to help with the pain and swelling. A few days later, the owner looks at his horse again. Now, the owner has invested his time and his money in bringing in this homeopath to examine his horse. He doesn’t want to feel like a fool if the remedy doesn’t work, which means that he has a psychological bias toward seeing an improvement in the condition of his horse. The same is true of the homeopathic vet — their professional reputation is on the line. If the horse doesn’t recover, the owner might be annoyed and might tell other owners that the vet is no good. The vet has also decided that homeopathy is the right thing to do to help this horse — if it turns out that he got it wrong, then he is going to feel like a fool.

So the owner and the homeopath both have a strong, subconscious, psychological bias toward seeing an improvement in the horse. And so they are far more likely to judge that the horse has shown some improvement, even if it hasn’t. They aren’t lying, they aren’t making it up. But they have fooled themselves into believing that the horse was worse than it was the first time they examined it, which therefore means the horse appears better now. This is a known, observed effect in psychology — and also provides another route by which an animal or baby can appear to be susceptible to “placebo effects” even though they can’t know or understand or “believe in” the medicine they are taking. When we are testing the effects of homeopathy, we need to rule these effects out too before we can attribute any improvement to the homeopathy.

I hope that explains a little more about why we believe what we do about homeopathy. As you say, the human body is an incredibly complex thing — and epidemiology is one of the most complicated areas of medical science. We trust that epidemiologists know their business, and when they tell us that the apparent effects of homeopathy cannot be reliably distinguished from the effects I’ve mentioned (plus many dozens of others) we accept their judgement… until the day comes when someone finds reliable tests that account for all of this and still shows an effect for homeopathy. And then, we’ll change our (open) minds, and we will do so happily. Because when it comes down to it, we are only interested in what can be shown to be true — whatever it might be!

Thanks again for your email.

Regards,

Mike Hall
The 10:23 Campaign

[Editor’s note: The reply to Emily has been updated to correct typos, however the practical content is unchanged]

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In a world where doctors are forced to rush through patients with little time to really get to the root cause (and hear I am referring to the NHS in which I worked as a GP) is it any wonder that people feel better when they see a homeopath and get an hour of their time discussing their problems?! The placebo effect is in fact purely placebo when referring to the ‘medicine’ itself…the real effect, in my opinon, is the regular hourly sessions of counselling that they receive.

This response to Emily’s email was very civil and well reasoned, though of course, even with controlled studies there are numerous problems with objectivity. Nothing in these studies is perfect, but your explanation of the ‘nat’l history of disease’, as well the measurable ‘regression to the mean’ principle, was excellent.

I only wish whomever replied to my comment to your post on FB had shown equally cordial and reasoned thought. Had I been someone else, I might easily have dismissed your purpose.

The above explanation, in briefer form, might serve well a rationale against Homeopathy, rather than a summary dismissal as “absurd.” Of course the subject of adequate funding for truly objective, double-blind studies in non-priority studies is another problem, and I doubt Homeopathy is considered a priority study. Economics is a reality in research, both in size as well controls employed in studies.

While your reasoning with the principles noted is excellent, the subject of the theory of Homeopathy in practice would be useful to examine. Epidemiological studies have been wrong before — many times at that. The gentleman, or gentlewoman, who answered my comment on FB simply dismissed Homeopathy as “absurd.” Bloodletting is generally now considered absurd, though it wasn’t always. Such is the progression of knowledge.

I do wonder if there are physiological mechanisms of response in the body to homeopathic remedies that we have yet to discover. There is such a thing as a healing crisis in illness/recovery. Too, there is such a thing as intrinsic bias in fallible human beings who conduct epidemiological studies, as evidenced in your example of the homeopathic veterinarian and horse owner. Teasing out these biases is not always easy, but we would not be entirely honest in neglecting to mention that they, too, exist.

Statistical controlled studies are powerfully persuasive, but they’ve yet to achieve 100% objectivity, and that might not be achievable given the human element, a complex subject. I’m thinking also, of course, of the powerful economic incentives that are the eternal bane of good science, as well all other aspects of human life.